Though we have provided a few helpful hints for vaccinating your Medicare patients below, this article does not serve as a guarantee of payment. Furthermore, it is vital that your patient contacts their insurance plan directly if they have any questions about their coverage prior to vaccination.
Medicare B only routinely covers flu, Pneumovax, and Prevnar in an outpatient setting. The patient typically does not require a copay, and rarely will a patient receive a bill, unless they receive a duplicate vaccine in the given time period.
Medicare B generally covers one flu shot per season. Pneumovax and Prevnar are generally covered as well, but they must be given a full calendar year apart according to Medicare requirements.
All Medicare patients will show up on the Scheduler with a green yield sign, reminding you they are Eligible, but only for flu, Pneumovax, and Prevnar. Medicare Advantage plans almost always adhere to these same eligibility rules, and our system will recognize patients with advantage plans as Medicare patients.
What about Medicare D?
If the patient also has Medicare D, you will see an additional eligibility icon that looks like a red dollar sign. If the patient wishes to receive any of the vaccines listed under the Medicare D pop-up box, you must enter the copay information before administering. We cannot accept cash for Medicare D copays. If the patient has Part B and only wishes to receive flu, Pneumovax, or Prevnar, you do not need to complete the Medicare D pop-up box or enter a credit or debit card.
If the patient only has Medicare Part B and does not have Medicare Part D, they need to self-pay for TDAP or Zoster, as they do not have insurance coverage that will cover the cost of these vaccines.
For more information on checking eligibility for Medicare D patients, check out our Med D article HERE.
For further questions, please contact our billing department via our primary VaxCare number below.
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